Plateau Iris post LPI

[Lower21]

HI

looking for some clarity, I recently had a laser iridotomy as a preventative treatment narrow angles & plateau iris configuration pressures where within normal range.

Post laser no visual issues non pressure spikes etc , I had my follow up last Friday and as usual left with more questions than answers,

The consultant checked using SLT lamp and checked my pressures and simply said ‘ I’m happy with everything all looks good, I’m happy to let you go ‘

I was so shocked I didn’t ask what I wanted, my husband asked about medications he said should be fine now as I have protection from the iridotomy

He also said dark / dim lighting shouldn’t be an issue

I asked if my angles where open / closed when what I’d meant to say is have my angles opened MORE 🤦‍♀️ he just said ‘open’ prior to r they where very narrow but open - so who knows

He mentioned that the iridotomy doesn’t prevent the angle closing if the iris / plateau pushes forward . . .

So what on earth have I just been through all of this for? And why would he want to discharge me when literally EVERYTHiNG I’ve read online states plateau iris requires ongoing monitoring

I’m absolutely distraught, I’m hoping someone may be able to advise.

thanks for reading.

[Trish_GlaucomaUK Partner]

Hello,

Having plateau iris can increase the risk of primary angle glaucoma but it does not always the case.

As you have had a successful iridotomy it will decrease the risk of PACG from developing but I am surprised to read that the consultant has already discharged you. Normally a person would stay in the clinic for a while longer to make sure the iridotomy is still working and then, the consultant may consider discharging you and recommend you have regular checks at your opticians. I would call the eye secretary with your concerns. They will be able to relay them to the consultant and get back to you.

The iridotomy does not widen the angle, but it does give additional drainage.

[Lower21 in reply to Trish_GlaucomaUK]

Is this why he didn’t do a gonioscopy to check the angle afterwards as it wouldn’t improve / widen anyway?

I am now being seen in three months - I wasn’t happy with the discharge, I’m now questioning the credibility of the consultant

Thankyou for getting pack to me

[Trish_GlaucomaUK Partner in reply to Lower21]

Yes this is why he do a gonioscopy. I'm glad you are now being seen to check that the iriditomy is still working.

Remember, you can always go for a second opinion if you are not happy with the consultant. You can either go to your GP and ask to be referred for a 2nd opinion to another hospital. This can quite a long time though. The other option is to see someone privately. Just do a search for glaucoma specialists in your area or, if there is a particular eye hospital you wish to go to, just type the name of the hospital followed by private clinic. Eye hospitals normally have a private eye clinic.

[Lower21 in reply to Trish_GlaucomaUK]

Hi sorry no he didn’t do the gonioscopy after the 4 week post laser check. Just used the slit lamp

[Lower21 in reply to Trish_GlaucomaUK]

Hi sorry no he didn’t do the gonioscopy after the 4 week post laser check. Just used the slit lamp

[Bess21 in reply to Lower21]

My angles opened from grade 1 to 2 and 3. They grade angles 0 to 4 widest fully open is 4

[Lower21 in reply to Bess21]

That’s great for you - it mine won’t open anymore due to plateau iris - don’t have this?

[Bess21 in reply to Lower21]

Is next step lens replacement?

[Lower21 in reply to Bess21]

Sorry I meant to say do you have plateau iris?

No idea

[Bess21 in reply to Lower21]

No I haven't I need lens replacement surgery next due to pressures and mild cataracts. Hope you get another opinion

[Lower21 in reply to Bess21]

Good luck with Everything

[USME]

Amazing! I suggest finding another doctor ASAP. Good luck, God bless.

[Lower21 in reply to USME]

Oh dear - do you have plateau iris?

[USME]

No I do not. I've been in tx for Glaucoma for nearly 40 years with many other complications. I've been fortunate to have several, not every doctor, willing to patiently answer my questions , listen to my concerns and explain every procedure thoroughly. I believe a good, trusting relationship with your doctor makes a hugh difference in the care and mental health of the patient, especially when dealing with devastating diseases such as Glaucoma. I am in the US and the health care system is not great but I am amazed at what you all deal with in the UK. Good luck, God bless.

[Lower21 in reply to USME]

It’s horrendous here - I have no faith in the NHS anymore. Thankyou for your reply. Good look to you also, take care.

[Bess21 in reply to Lower21]

Where are you in uk

[Lower21 in reply to Bess21]

North

[Bess21 in reply to Lower21]

I am midlands

[Sorshup]

A few simples: "happy to let you go" may just have been a reassurance, and you may find you are on a 6///12 or even 1 year follow up, if very low risk.

But what we don't know ftom you is - why were you referred to hospital in the firdt place? The inference is that someone considered you to be at risk (and unlikely to be the PI alone), but is true that only occasional IOP monitorign is of little help if IOP spikes are likely. Chat further with consultant and optometrist.

[Lower21 in reply to Sorshup]

I was originally referred due to a condition called IIH which caused swelling of the optic nerve, however since having a lumbar puncture that has resolved and I have no damage to the nerve,

My narrow angles where picked up purely by accident whilst having all manner of tests for IIH this was back in 2016

Nothing was mentioned, however I had an appointment clinic with an advanced nurse practitioner who was very thorough and told me about narrow angles, I queried this, she referred me to consultant, they arranged a UBM scan, plateau iris configuration was confirmed and they did the LPI PROPHYLACTIC.

[Lower21 in reply to Sorshup]

to add - it was my optometrist at vision express ( who is absolutely incredible I might add )who did the original referral in 2016

[Sorshup]

Well, well ! Very interesting! You could decide to forget all about it (though a doctor,fearing a negligence claim would be reticent to suggest it.)There must be thousands in ignorance of their PI and so living with some degree of vulnerability to acute closed angle attack and many more with unregnised OHT. Unless the hospital does keep you on, I think an annual NHS sight test, with additional nerve head OCT, check and, for a couple of years, quarterly IOP checks with yopur cooperative optometrist just to see if there is some IOP variability. Of course you should be aware of an acute attack which theoretically will cause pain, haloes, blurring so you should know if that does happen. Mind you, that's just what the textbooks say......

[Lower21 in reply to Sorshup]

Very informative. Thankyou for that.

Ah yes the text book norms, thus far I have evaded the ‘norms’ when I was diagnosed with IIH by the neurologist they couldn’t believe how high my inter cranial pressure was, norm is between 5-15 mine was 33! No headaches nothing at all, completely asymptomatic except for the swelling which I didn’t realise as my vision wasn’t effected,

The neurologist said I was somewhat of a ‘medical zebra’

Yes I did wonder the same, how many people are walking around blissfully unaware.

I think I must consider myself very lucky!